The Brussels consensus for non-invasive ICP monitoring when invasive systems are not available in the care of TBI patients (the B-ICONIC consensus, recommendations, and management algorithm)

Intensive Care Medicine, Год журнала: 2025, Номер unknown

Опубликована: Янв. 23, 2025

Язык: Английский

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A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts

Neurocritical Care, Год журнала: 2024, Номер 41(3), С. 880 - 892

Опубликована: Май 29, 2024

Abstract Background Numerous trials have addressed intracranial pressure (ICP) management in neurocritical care. However, identifying its harmful thresholds and controlling ICP remain challenging terms of improving outcomes. Evidence suggests that an individualized approach is necessary for establishing tolerance limits ICP, incorporating factors such as waveform (ICPW) or pulse morphology along with additional data provided by other invasive (e.g., brain oximetry) noninvasive monitoring (NIM) methods transcranial Doppler, optic nerve sheath diameter ultrasound, pupillometry). This study aims to assess current practices among experienced clinicians explore whether guidelines should incorporate ancillary parameters from NIM ICPW future updates. Methods We conducted a survey professionals involved researching managing patients severe injury across low-middle-income countries (LMICs) high-income (HICs). sought their insights on monitoring, particularly focusing the impact various clinical scenarios. Results From October December 2023, 109 Americas Europe participated survey, evenly distributed between LMIC HIC. When ranged 22 25 mm Hg, 62.3% respondents were open considering information, techniques, before adjusting therapy intensity levels. Moreover, 77% inclined reassess 18–22 Hg range, potentially escalating levels support NIM. Differences emerged HIC participants, more preferring arterial blood transducer leveling at heart endorsing use techniques information. Conclusions Experienced tend personalize management, emphasizing importance techniques. settings, warrant further exploration could enhance patient The updating include these components personalized management.

Язык: Английский

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Predicting short-term outcomes in brain-injured patients: a comprehensive approach with transcranial Doppler and intracranial compliance assessment

Journal of Clinical Monitoring and Computing, Год журнала: 2024, Номер unknown

Опубликована: Июнь 6, 2024

Abstract Neurocritical patients frequently exhibit abnormalities in cerebral hemodynamics (CH) and/or intracranial compliance (ICC), all of which significantly impact their clinical outcomes. Transcranial Doppler (TCD) and the cranial micro-deformation sensor (B4C) are valuable techniques for assessing CH ICC, respectively. However, there is a scarcity data regarding predictive value these determining patient We prospectively included neurocritical undergoing pressure (ICP) monitoring within first 5 days hospital admission TCD B4C assessments. Comprehensive were collected alongside parameters obtained from (including estimated ICP [eICP] perfusion [eCPP]) (measured as P2/P1 ratio). These evaluated individually well combination. The short-term outcomes (STO) interest therapy intensity levels (TIL) management recommended by Seattle International Brain Injury Consensus Conference, TIL 0 (STO 1), 1–3 2) death 3), at seventh day after last collection. dataset was randomly separated test training samples, area under curve (AUC) used to represent noninvasive ability on STO prediction association with ICP. A total 98 included, 67% having experienced severe traumatic brain injury 15% subarachnoid hemorrhage, whilst remaining had ischemic or hemorrhagic stroke. ICP, P2/P1, eCPP demonstrated highest predict early mortality ( p = 0.02, 0.006, respectively). only parameter significant 1 0.03). Combining parameters, AUC 0.85 using + eCPP, whereas 0.72 identify > 20 mmHg eICP. combined neuromonitoring approach ratio improved performance predicting during phase acute injury. correlation hypertension moderate, means eICP ratio. results support need interpretation this information ICU warrant further investigations definition strategies ancillary tests.

Язык: Английский

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Characterization of intracranial compliance in healthy subjects using a noninvasive method - results from a multicenter prospective observational study

Journal of Clinical Monitoring and Computing, Год журнала: 2024, Номер 38(6), С. 1249 - 1261

Опубликована: Июль 20, 2024

Abstract Purpose An FDA-approved non-invasive intracranial pressure (ICP) monitoring system enables the assessment of ICP waveforms by revealing and analyzing their morphological variations parameters associated with compliance, such as P2/P1 ratio time-to-peak (TTP). The aim this study is to characterize compliance in healthy volunteers across different age groups. Methods Healthy participants, both sexes, aged from 9 74 years old were monitored for 5 min supine position at 0º. Age was stratified into 4 groups: children (≤ 7 years); young adults (18 ≤ 44 middle-aged (45 64 older (≥ 65 years). data obtained waveform, TTP. Results From December 2020 February 2023, 188 assessed, whom 104 male, a median (interquartile range) 41 (29–51), body mass index 25.09 (22.57–28.04). Men exhibited lower values compared women TTP ( p < 0.001). There relative rise increased Conclusions revealed that are influenced sex individuals, men displaying than women, ratios increasing age. These findings suggest potential avenues further research larger more diverse samples establish reference comparison various health conditions. Trial registration Brazilian Registry Clinical Trials (RBR-9nv2h42), retrospectively registered 05/24/2022. UTN: U1111-1266-8006.

Язык: Английский

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Cerebrovascular Responses in a Patient with Lundberg B Waves Following Subarachnoid Haemorrhage Assessed with a Novel Non-Invasive Brain Pulse Monitor: A Case Report

Medical Devices Evidence and Research, Год журнала: 2024, Номер Volume 17, С. 73 - 87

Опубликована: Фев. 1, 2024

Subarachnoid haemorrhage (SAH) can trigger a range of poorly understood cerebrovascular responses that may play role in delayed cerebral ischemia.The brain pulse monitor is novel non-invasive device detects photoplethysmography signal provides information on intracranial pressure (ICP), compliance, blood flow and tissue oxygen saturation.We monitored the patient with Lundberg B waves following SAH.The presented Fischer grade 4 SAH required urgent left posterior communicating artery aneurysm coiling ventricular drain insertion.On hospital day oscillations or spikes invasive ICP were noted, consistent waves.Brain monitoring demonstrated concurrent waveform features reduced compliance raised over both hemispheres.Oxygen levels also slow correlated spikes.Brief infrequent episodes absent pulses noted right hemisphere.Our findings suggest holds promise for early detection ischemia could offer insights into vascular mechanisms at play. Plain Language Summary:In this study, we examined serious bleed, known as subarachnoid hemorrhage (SAH).Patients suffer from vasospasm consequent (DCI), which happen to 14 days after initial bleeding.Detecting treating DCI difficult because methods are imperfect, discontinuous technically difficult.We used new, various health.This helps us understand inside skull, flow, saturation surface brain.In patient, found evidence of:• Brain signals directly related acute changes pressure.• Specific patterns indicate local reduction flow.• Signs breakdown brain's ability regulate injured hemisphere.• The changes.These results promising they new help identify when someone's condition getting worse.This guide development improved care protocols, aid clinical decision-making.Further research needed population additional forms generalizability our findings.

Язык: Английский

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Noninvasive neuromonitoring in acute brain injured patients

Intensive Care Medicine, Год журнала: 2024, Номер 50(6), С. 960 - 963

Опубликована: Апрель 17, 2024

Язык: Английский

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Machine learning approach for noninvasive intracranial pressure estimation using pulsatile cranial expansion waveforms

npj Digital Medicine, Год журнала: 2025, Номер 8(1)

Опубликована: Янв. 26, 2025

Abstract Noninvasive methods for intracranial pressure (ICP) monitoring have emerged, but none has successfully replaced invasive techniques. This observational study developed and tested a machine learning (ML) model to estimate ICP using waveforms from cranial extensometer device (brain4care [B4C] System). The explored multiple waveform parameters optimize mean estimation. Data 112 neurocritical patients with acute brain injuries were used, 92 randomly assigned training testing, 20 reserved independent validation. ML achieved absolute error of 3.00 mmHg, 95% confidence interval within ±7.5 mmHg. Approximately 72% estimates the validation sample 0-4 mmHg values. proof-of-concept demonstrates that noninvasive estimation via B4C System is feasible. Prospective studies are needed validate model’s clinical utility across diverse settings.

Язык: Английский

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Validation of a Noninvasive Approach for Cerebrospinal Compliance Monitoring

Neurocritical Care, Год журнала: 2025, Номер unknown

Опубликована: Фев. 7, 2025

Язык: Английский

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Unlocking the potential of high-resolution multimodality neuromonitoring for traumatic brain injury management: lessons and insights from cases, events, and patterns

Critical Care, Год журнала: 2025, Номер 29(1)

Опубликована: Март 31, 2025

Abstract Multimodality neuromonitoring represents a crucial cornerstone for patient management after acute brain injury. Despite the potential of multimodality (particularly high-resolution data) to transform care, its full benefits are not yet universally realized. There remains critical need integrate interpretation complex patterns and indices into real-time clinical decision-making processes. This requires multidisciplinary approach, evaluate discuss implications observed in timely manner, ideally close temporal proximity their occurrence. Such collaborative effort could enable clinicians harness multimodal data. In this educational case-based scoping review, we aim provide clinicians, researchers, healthcare professionals with detailed, compelling examples applications neuromonitoring, focused on modalities within field traumatic case series showcases how such as intracranial pressure, tissue oxygenation, near-infrared spectroscopy, transcranial Doppler can be integrated cerebral microdialysis, neuroimaging systemic physiology monitoring. The is demonstrate value approach based data derived one monitoring tool, allowing improvement diagnosis, monitoring, treatment patients For purpose, key concepts covered, various cases have been described illustrate make most advanced technology.

Язык: Английский

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Clinical Performance of the Brain4care System for Noninvasive Detection of Intracranial Hypertension

Neurocritical Care, Год журнала: 2025, Номер unknown

Опубликована: Апрель 28, 2025

Язык: Английский

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